Many hospitals are finding physicians to be less willing to take on roles beyond clinical work, leaving leaders scrambling to create new methods to attract physicians to administrative or faculty roles. However, this is an issue academic medical centers solved decades ago.
“The academic model for physicians involves splitting time between clinical responsibilities and academic responsibilities that include research, teaching, quality improvement, hospital operations and/or strategic planning,” Joseph St. Geme III, MD, physician-in-chief and chair of the department of pediatrics at Children’s Hospital of Philadelphia, told Becker’s. “Accordingly, physicians who are working in academic settings are generally splitting their effort already.”
This structure addresses a primary driver behind shrinking interest in leadership roles: work-life balance. Academic centers have been using it for decades with some promising results.
The history of split roles
Academic medicine has used split role models “partly because academic physicians historically weren’t paid as well, and they were expected to do more — to write, publish and contribute to their field,” Patrick Cawley, MD, CEO of Charleston-based Medical University of South Carolina, told Becker’s.
The formula is mutually beneficial, allowing physicians to engage in work that aligns with their specialty and then publish or teach on that subject, which benefits the medical center. However, hospitals outside of academia have been slow to adopt this strategy, often due to compensation complications.
Dr. Cawley has been in medicine for about 22 years and worked in both academic medicine and community hospitals.
“I was honestly a little shocked that the practice of buying out physician time wasn’t really done in the community setting,” he said while describing his move into a community hospital. “In fact, at that time, many community hospitals didn’t even have a chief medical officer. Traditional medical staff leadership came through the medical staff itself. But things started to change as physician compensation evolved. As [relative value unit]-based pay became more prominent — and as hospitals hadn’t yet factored in acuity — physicians started realizing the value of their time. Hospitals would ask for four hours a week, maybe one half-day, to participate in leadership. And physicians would quickly calculate how many RVUs they were losing.”
That started conversations between physicians and hospitals on how to account for the time spent in administrative tasks. Community hospitals have started working through how to manage these compensation differences.
“Over time, we’ve just gotten very used to buying out physician time,” Dr. Cawley said. “There are different methodologies, but it always comes down to: how much time are you buying, and what are you asking them to do? Community hospitals haven’t completely caught up with academic centers, but the gap has narrowed. Years ago, they were miles apart. Now, they’re inches apart.”
Where split roles stand today
Leaders at six academic medical centers said that at least half of their physicians hold some form of dual role. These roles range from clinical leadership, faculty members, department chairs and physician researchers.
How responsibilities are divided depends on the role and the person. Tyler Barrett, MD, associate chief medical officer for compliance and professor of emergency medicine at Nashville, Tenn.-based Vanderbilt University Medical Center, works his administrative role on the weekdays and practices as an emergency medicine physician on weekends, evenings and occasional weekdays.
“I wouldn’t have taken this role if it meant working every weekend clinically and five full administrative days,” he told Becker’s.
Departments create their own roles and structure for split time depending on their needs. Some physicians may only spend 5% of their time on administrative or teaching duties, while others might spend 90%. Across academic medical centers, the most common division appears to be 20% to 25% spent on administrative or faculty roles.
In some cases, a person might lead a short-term, highly focused project for six months to a year before returning to full-time clinical work. These projects are often entry points into leadership for physicians at Vanderbilt.
Regardless of position, most clinicians in academic centers are dedicated to what’s called the triple mission: research, education and patient care — plus administration, Edmund Pribitkin, MD, president of the Jefferson Medical Group, and chief physician executive at Jefferson Health, both based in Philadelphia, told Becker’s. This combined mission creates a culture that encourages intertwining work.
After decades of managing and creating split roles, academic centers have found several best practices that community hospitals can use.
Best practices from decades of experience
Paul Wallach, MD, vice chancellor for health sciences education and executive vice dean for academic affairs at the University of Pittsburgh School of Medicine — and a long-time leader and physician in academic medicine — said that one of the best parts of effective split roles is it doesn’t “feel like a split — it was just how the job worked. It wasn’t like I taught ‘Algebra 204’ on a schedule. As an internist, I had students and residents working alongside me during their clerkships, participating in clinical care. Yes, I gave lectures and led conferences, but it was all integrated. It felt continuous and seamless.”
Making these roles feel seamless begins with reframing additional responsibilities — whether teaching, mentoring or research — as a source of professional satisfaction.
“Yes, it takes time,” he said. “It may slow you down a bit. But most would agree that it’s worth the trade-off. The same goes for research. When you know you’ve contributed to a better way to treat breast cancer or heart attacks or Alzheimer’s, that’s deeply rewarding for those of us who went into medicine to make a difference.”
For leaders designing these roles for their hospital, introducing the new structure can be hard and there’s often fear about the extra time and responsibilities, Dr. Wallach said.
“But like anything new, people learn,” he said. “These are smart, capable physicians and these are learnable skills. They can learn how to incorporate learners onto their teams in ways that are efficient and effective. In fact, residents and students can often help speed up parts of the day. So it’s about openness — recognizing that these activities aren’t just added tasks, but meaningful work in their own right.”
Charlotte, N.C.-based Advocate Health is seeing more and more physicians interested in leadership roles. This is largely due to its initiatives to improve leadership and development opportunities for physicians and advanced practice providers, as well as focusing on well-being, Suzanna Fox, MD, enterprise chief physician executive at Advocate Health , told Becker’s. Their secret: learning from conversations. When designing a new role, they focus on how it is connected to the academic mission, the clinical mission, and its alignment with enterprisewide or division-specific goals.
“We use mentoring and leadership development to help faculty evolve into positions where they’re balancing both clinical and academic work,” she said. “We’ve seen a significant decrease in burnout and an increase in career satisfaction among those in dual roles. You won’t be successful in building academic-clinical collaboration unless you see it as part of your well-being strategy.”
The next critical element is clarity and transparency.
“You need to be clear about goals — what the administrative or educational role entails — and how success will be measured,” Dr. Pribitkin said. “If I were applying for a split role, my first question would be: What does success look like, both clinically and administratively?”
If the organization cannot answer those questions, the role is set up to fail. Beyond clarity in expectations comes the need to provide physicians with the proper resources.
“Too often, someone’s handed a job and no tools,” he said. “That’s a recipe for burnout. You need an ecosystem: clear role descriptions, aligned support, defined success metrics and resourced teams. Otherwise, you’ll see turnover within six months. For organizations just getting started, I’d say: Build the ecosystem before launching the role. That’s how you ensure success.”
On the system side, it’s vital to define the reporting structure and separate it by function. Split roles do not work by having a single supervisor, Dr. Pribitkin said. There should be different supervisors for each side of the role.
“At Jefferson, we’ve developed a function-based reporting structure,” he said. “People are reviewed according to what they do in each role. That’s essential for accountability and development.”
When choosing who to fill these dual roles, it’s important to select individuals with the right skill set. There are two critical traits for success in healthcare leadership, Dr. Barrett said. First is someone who can tailor your message to the audience, and second is follow-through.
“Many people have great ideas,” he said. “But executing them — taking something from inception to completion — is much rarer. The people who can do both are your future stars. You have to identify and invest in them.”
Investing in them includes not just mentoring, but creating succession plans.
“Many leaders — myself included — hesitate to take on new roles because we worry about what happens to the work we’ve built,” Dr. Barrett said. “It’s not ego; it’s about ensuring continuity and growth. You want someone who can step in, carry things forward, and ideally do even better. Succession planning is especially important as systems expand and acquire new hospitals. You may not be leaving your current role, but your organization might need you elsewhere. Having that bench strength makes transitions possible.”
And then there’s compensation — one of the trickiest parts of creating a split role.
The methodology for buying out a physician’s time for other roles can get complicated, especially when considering their average productivity level and pay rate.
“If a physician is working at an average productivity level, and you’re paying out at an average rate, it’s straightforward,” Dr. Cawley said. “The challenge comes when the physician is working at a higher-than-average productivity level. Do you buy out their time at the average rate or at their actual productivity rate? Or maybe you land somewhere in between. The same applies on the other end of the spectrum. If a physician is underperforming — earning, say, $50,000 — it might seem like a bargain to buy out 20% of their time for $10,000. But most physicians know what the average rate is and will expect compensation aligned with that $20,000 figure, even if their productivity is lower.”
Creating the proper methodology for determining compensation will take time, but once it’s established, it becomes a project you revisit every five or so years, he said.
Advantages
Although creating split roles can be time-consuming and difficult, the advantages far exceed the start-up costs. These advantages include:
1. The presence of learners.
“When I was practicing intensively, students or residents would often notice something I hadn’t, and we’d talk through it, return to the patient together, and sometimes improve the outcome because of that collaboration,” Dr. Wallach said. “That’s the joy of academic medicine: patients often receive more attention, not less. And as the physician leading the team, I felt more fulfilled at the end of the day knowing I had helped care for patients while mentoring the next generation. It absolutely contributed to my wellness and satisfaction in the work.”
2. Training the next generation.
“We know that at some point all of us will age out and retire. It’s critical that we’ve trained the next generation to carry the torch — and that happens by involving learners on our clinical teams,” Dr. Wallach said.
3. A range of work options supports well-being.
“We know people are more likely to stay in roles they love,” Dr. Fox said. “It also allows us to model for our rising learners — residents and medical students — and show them what their career path could look like.”
4. Reduce silos and improve collaboration.
“The days of siloing academic and clinical physicians are over,” Dr. Fox said. “If you want to build a true learning health system, you have to bring those worlds together. When those two align, we see a dramatic increase in clinical trial activity and collaboration. That kind of integration strengthens both the clinical and academic missions. And when our service line leaders have academic backgrounds, it supports better stewardship — not just of academic medicine but also of business operations. They can see the full picture, not just one silo.”
More clinicians are specializing, “but cross-pollination is incredibly valuable,” Dr. Pribitkin said. “When clinicians work in education and administration — and vice versa — the entire system benefits. It prevents siloing.”
5. Greater efficiency for hospitals.
“If I have a physician with 20% of their time bought out, I can call on them to attend meetings, help shape policies, review data — whatever we need,” Dr. Cawley said. “I’m not guessing whether something will get done. If I can’t find someone internally, I’d have to bring in a consultant. But if I have an engaged physician leader in-house, it’s much more efficient.”
6. Increasing physician and nurse engagement.
“When you have your physicians and nurses aligned and involved in system-level decision-making, great things happen,” Dr. Crawley said. “You avoid conflict, solve problems collaboratively and build trust.”
Being able to step away from clinical work to do other tasks can also provide balance. “It allows you to recharge and re-engage from a different angle,” Dr. Barrett said.
7. Greater flexibility in work schedule.
“While administrative work may mean more total hours, it often gives you more control over your schedule,” Dr. Barrett said. “For me, that was key. I’m a night owl, so I’d often work late at night and use Outlook’s scheduled send feature to deliver emails at 7 a.m. That flexibility lets me stay engaged at work while being present at home.”
